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Transplantation ; 90(3): 286-91, 2010 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-20571467


BACKGROUND: Kidneys from elderly donors tend to be implanted in recipients who are also elderly. We present the results obtained after 10 years of evolution on transplanting elderly kidneys into young recipients. METHODS: Ninety-one consecutive transplants are studied, carried out in our center with kidneys from cadaver donors older than 60 years implanted in recipients younger than 60 years. The control group is made up of 91 transplants, matched with those from the study group, whose donor and recipient were younger than 60 years. RESULTS: There were no differences between groups with regard to recipient age, sex, cause of death and renal function of the donor, hepatitis C and cytomegalovirus serologies, cold ischemia time, tubular necrosis, immediate diuresis, need for dialysis, human leukocyte antigen incompatibilities, hypersensitized patients, acute rejection, waiting time on dialysis, and days of admission. Survival in both groups at 1, 5, and 10 years was 97.6%, 87.2%, and 76.6% vs. 98.8%, 87.5%, and 69.5% for the patient (P=0.642), 92.9%, 81.3%, and 64.2% vs. 93.9%, 76.4%, and 69.5% for the graft (P=0.980), and 94.4%, 92.6%, and 77.4% vs. 94.3%, 86.7%, and 84.4% for the graft with death censured (P=0.747), respectively. Creatininaemias at 1, 5, and 10 years were 172, 175, and 210 vs. 139, 134, and 155 (P<0.05). CONCLUSIONS: We conclude that patient and graft survival on transplanting kidneys from elderly donors to young recipients is superimposable on that obtained with young donors. However, renal function is better in the group of young donors.

Seleção do Doador , Sobrevivência de Enxerto , Transplante de Rim , Alocação de Recursos , Doadores de Tecidos/provisão & distribução , Adulto , Fatores Etários , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Estimativa de Kaplan-Meier , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
Transplantation ; 83(10): 1345-50, 2007 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-17519785


BACKGROUND: Acceptance criteria for corneal donation in some eye banks include cadavers with active cancer, both solid and hematological. Such acceptance is based on the fact that the cornea is an avascular tissue and metastatic dissemination is extremely unlikely. METHODS: From a total of 588 corneal donors in the Sant Pau Tissue Bank (April 1999 to December 2003), 204 (34.7%) had an active malignancy or a history of malignancy. Of these, 177 had solid cancers and 27 had hematological cancers. Cancer was active in 94.7% and 64% had metastatic dissemination. A histopathological study of the 408 eyes from these 204 donors was performed to rule out metastasis. A total of 325 corneas (79.7%) were transplanted and recipients were followed for an average of 64.1 months (SD 11.1, range 30-86). RESULTS: The incidence of ocular metastases in the 204 donors with malignancy was 1%, 0.6% for solid cancer, and 3.7% for malignant hematological disease. There was no tumor transmission in any of the 325 recipients. CONCLUSIONS: The incidence of ocular metastases in corneal donors with active malignancy is very low. Donor-recipient tumor transmission through corneal transplantation is highly improbable when the eyes are free of cancer.

Transplante de Córnea , Neoplasias Hematológicas/patologia , Neoplasias/patologia , Doadores de Tecidos , Enucleação Ocular , Neoplasias Oculares/epidemiologia , Feminino , Seguimentos , Neoplasias Hematológicas/epidemiologia , Humanos , Incidência , Masculino , Neoplasias/epidemiologia , Preservação de Órgãos , Seleção de Pacientes , Estudos Retrospectivos , Medição de Risco , Espanha , Coleta de Tecidos e Órgãos
Am J Transplant ; 5(4 Pt 1): 781-7, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15760402


Bacterial infections are frequent in cadaveric organ donors and can be transmitted to the transplantation recipient, which could have devastating consequences for the recipients if adequate preventive measures are not adopted. From the 355 consecutive brain dead cadaveric organ donors procured at our center in the last four years, 2000-2003, four of them (1.1%) had bacterial endocarditis as cause of death. The bacteria responsible for the endocarditis were Staphylococcus epidermidis, coagulase-negative Staphylococcus, Staphylococcus hominis and Streptococcus viridans, respectively. We performed five kidney and two liver transplantations on seven recipients. All donors and recipients received antibiotic treatment against the germ causing the respective endocarditis. Infection by the bacteria responsible for the endocarditis in the respective donors was not transmitted to any of the recipients. Six of the seven recipients were alive with normal-functioning grafts after between 13 and 24 months' follow-up. Transplantectomy was performed on one kidney recipient due to thrombosis of the renal vein of the graft not related to the endocarditis. Liver and kidney transplantation from donors dying from bacterial endocarditis can be performed without causing the transmission of infection to the recipient or the dysfunction of the graft.

Endocardite Bacteriana , Transplante de Rim , Transplante de Fígado , Infecções Estafilocócicas , Doadores de Tecidos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Staphylococcus epidermidis , Staphylococcus hominis , Obtenção de Tecidos e Órgãos
Clin Transplant ; 17(4): 308-24, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12868987


The terms extended donor or expanded donor mean changes in donor acceptability criteria. In almost all cases, the negative connotations of these terms cannot be justified. Factors considered to affect donor or organ acceptability have changed with time, after showing that they did not negatively affect graft or patient survival per se or when the adequate measures had been adopted. There is no age limit to be an organ donor. Kidney and liver transplantation from donors older than 65 years can have excellent graft and patient actuarial survival and graft function. Using these donors can be from an epidemiological point of view the most important factor to esablish the final number of cadaveric liver and kidney transplantations. Organs with broad structural parenchyma lesion with preserved functional reserve and organs with reversible functional impairment can be safely transplanted. Bacterial and fungal donor infection with the adequate antibiotic treatment of donor and/or recipient prevents infection in the latter. The organs, including the liver, from donors with infection by the hepatitis B and C viruses can be safely transplanted to recipients with infection by the same viruses, respectively. Poisoned donors and non-heart-beating donors, grafts from transplant recipients, reuse of grafts, domino transplant and splitting of one liver for two recipients can be an important and safe source of organs for transplantation.

Doadores de Tecidos , Obtenção de Tecidos e Órgãos , Adulto , Fatores Etários , Idoso , Infecções Bacterianas , Cadáver , Hepatite B , Hepatite C , Humanos , Transplante de Rim , Transplante de Fígado , Doadores Vivos , Micoses , Envenenamento , Segurança , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/normas
Clin Transplant ; 17(2): 89-92, 2003 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12709072


One to two percent of the general population of western countries are regular consumers of cocaine, 10% being sporadic consumers. This proportion increases considerably in the population age groups which are most frequently organ donors. Cocaine may directly cause brain death, or be present in those with brain death who died from other causes, especially head trauma. We present a 30-yr-old female donor, a regular consumer of inhaled cocaine, who died of brain anoxia after cocaine inhalation. Twenty-five hours after cocaine inhalation, the liver and kidneys were removed for transplantation. The liver was transplanted to a patient with acute hepatocellular failure caused by isoniazids, and the kidneys to two recipients with renal polycystosis. Toxicity attributable to the cocaine was not observed in any of the three recipients. All three grafts presented immediate function, and the clinical evolution of all three recipients and the function of all three grafts were excellent during the 5 yr of follow-up. The serum creatinines of the two kidney recipients 5 yr from transplantation were 76 and 72 micro mol/L, respectively.

Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína/envenenamento , Transplante de Rim , Transplante de Fígado , Doadores de Tecidos , Adulto , Morte Encefálica , Feminino , Humanos , Hipóxia Encefálica/etiologia , Resultado do Tratamento
Transplantation ; 74(4): 532-7, 2002 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-12352914


BACKGROUND: Ecstasy is a neurotoxic and hepatotoxic drug. Brain edema and fulminant hepatic failure are two of the most serious complications associated with the consumption of ecstasy. Acute ecstasy intoxication can transform a patient into an organ donor or a hepatic graft recipient. MATERIALS AND METHODS: In the last 5 years in our centers, we have had two multiorgan donors who died from ecstasy-induced brain edema and three patients who required urgent orthotopic liver transplantation for treatment of severe acute hepatocellular failure induced by this drug. We performed eight transplantations using the organs of these two brain-dead donors: one heart, one bipulmonary, three kidneys, one kidney-pancreas, and two livers. RESULTS: Toxicity caused by ecstasy was not observed in any of the eight patients who underwent transplantation. The clinical state and the graft function of the heart, two liver, renopancreatic, and three kidney recipients were normal for a follow-up period that ranged between 7 months and 4.5 years. The lung recipient died from multiorgan failure secondary to bilateral pneumonia 5 days after the transplantation, and one of the kidney transplant patients died as a result of intestinal lymphoma 6 months after transplantation. The three liver transplantations in the three patients with ecstasy-induced fulminant hepatic failure were performed successfully using orthotopic transplantation. These three recipients are asymptomatic and have normal-functioning hepatic grafts after follow-up of 3.5 years, 15 months, and 11 months, respectively. CONCLUSIONS: The thoracic and abdominal organs of people dying from ecstasy intoxication can be viable for transplantation. The short- and medium-term survival of the graft and of the recipient have been similar to that of other organ donors. Urgent liver transplantation is an effective therapeutic option in patients with ecstasy-induced acute hepatocellular failure.

Morte Encefálica , Falência Hepática/induzido quimicamente , Falência Hepática/cirurgia , Transplante de Fígado , N-Metil-3,4-Metilenodioxianfetamina/envenenamento , Doadores de Tecidos , Adolescente , Adulto , Feminino , Transplante de Coração , Humanos , Transplante de Rim , Transplante de Pulmão , Masculino , Pessoa de Meia-Idade , Transplante de Pâncreas